The DIY Information Technology Strategic Plan

1. The DIY Information Technology Strategic Plan Better Faster Cheaper Kirk Kirksey, Vice President for Information ResourcesUT Southwestern Medical Center Adjunct Professor, UT DallasChancellor’s Health IT Fellow, UT Systemkirk.kirksey@utsouthwestern.edu

2. Typical Strategic Planning Consulting Costs $300 per hour plus expenses

3. The IT Strategic Plan Why Plan? What Does Strategy Look Like? The Strategic Planning Process • A Brief Case Study • Your THoughts • What We Did Right, Where We Missed the Boat, and the New Picture.

4. The CHAOS Report • User Involvement 19 points • Executive Mgt Support 16 points • Clear Statement ofRequirements 15 points • Proper Planning 11 points • Realistic Expectations 10 points • Smaller Project Milestones 9 points • Competent Staff 8 points • Ownership 6 points • Clear Vision & Objectives 3 points • Hard-Working, Focused Staff 3 points Source: The Standish Group International

5. Mintzberg’s Strategy Types ♦ Prescriptive (in which normative assumptions derive from a view that the environment is relatively constant and the challenge for strategy development is to respond or adjust to the environment) 􀂾 Design school 􀂾 Planning school 􀂾 Positioning school ♦ Descriptive (in which the approach is derived from empirical findings or disciplinary perspectives and methods) 􀂾 Entrepreneurial school 􀂾 Cognitive school 􀂾 Learning school 􀂾 Cultural school 􀂾 Political school 􀂾 Environmental school

6. Core “Design School” Model of Strategy Formulation Derived from The Rise and Fall of Strategic Planning,Henry Mintzberg

7. Is IT Planning Worth IT?????

8. What Does Strategy Look Like? Strategic Choice Making

9. Supreme Court Justice Potter Stewart "I Know It When I See It”

10. The Von Schieffen Plan

11. Strategy Map and Balanced Scorecardfor Southwest Airlines

12. Recognizable ProductNew Market Position Same MarketsNew Perspective Could This Work? Position and Perspective Strategy as Perspective New Old New Strategy as Position Old Big Mac Original

13. WalMart – What were they thinking???? SUPERCENTERS NEIGHBORHOOD MARKET a). Grocery/pharmacy combo.b). Average size 43,000 sqftc). Preferred access – neighborhood accessd). Same Stuff a). All things to all people.b). Average size 187,000 sqftc). Preferred access – major transport artery

14. The IT Strategic Plan

15. Start with the End in MindThe Strategic Plan Table of Contents • The Glue (NOT the Mission/Vision Thang) • List of proposed projects, budgets and timelines supporting vision and goals of the organization. • The technology organization needed to successfully deliver these projects • Governance structure capable of implementation and enforcement

16. Analyze Gaps Management Of IT Applications Technology UTSW IT Strategic Planning Approach Initiate Project Develop Strategy Develop Alternatives Define Strategic Context Select Strategy Business Priorities, Guardrails & Assumptions Define Plan Vision for IT Assess IT Effectiveness Communicate Plan Customer Perception Strategy Communication Document Performance Strategy Implementation Plan Management of IT

17. Establishing Strategic Planning Governance • Scope (what is being governed) • Decision (who makes decision) • Input (who has input) • Mechanisms (more meetings)

18. The Governance of Strategic Planning Final Approval for IT Strategy and Financing Executive Steering Committee (EST)1 Meeting/Qtr Final Approval for Strategy Recommendation Project Steering Committee1 Meeting per Week strategy formulation Gather External/Internal Information Office of the CIO Consulting Team Representative Workgroups Provide Targeted Input

19. Glue vs The Inarguable Option To attract, recruit, and hire quality individuals to be employees of the City of XXX; and develop, motivate, reward, and recognize City of Dallas Employees. At Microsoft, we work to help people and businesses throughout the world realize their full potential. This is our mission. Everything we do reflects this mission and the values that make it possible. To be, for the long term, our customer’s primary trusted technology partner.

21. Recognizable ProductNew Market Position Where’s the Glue??

22. Our Glue • The 2004 IT Strategic Plan‘Systemness” – Create a seamless experience for physicians and patients across our clinical delivery enterprise.” • The 2010 IT Strategic Plan“Mission Integration” – Create a computing environment capable of securely integrating the clinical, education and research missions of UTSW.

23. Assess IT Effectiveness Customer Perception Moderate to high marks for ambulatory and university customers. Perceived as poor performers by hospital customers. Performance Variable performance based on ambulatory/inpatient boundaries. Management of IT Separate strategies for separate facilities. Little leverage of common resources.

24. Medical TV Telecommunications Ambulatory IT Hospital IT Client Services Network Services AdministrativeComputing The Information Resources Organization CIOVP For Information Resources 300 Employees$40M Operating Budget4% of Institution Operating Budget (1.2b)

25. Cerner Pathnet Pharmnet Radnet Analyze Technology Gaps Application Vulnerabilities – Clinical“Lots of Stable Applications, But They Are Old” High Access to Care Nursing Documentation System has technical problems, is being sunset or is on old architectures. Bad News McKesson IBAX Pharmacy Softmed HIM Suite Technical Risk MISYS Laboratory Info System Good News Siemens PACS System has major deficiencies in functionalities and does not meet customer needs. Epic EMR OACIS CDR Epic Chart Tracking Functional Risk High

26. Application Vulnerabilities – Financial“Many Applications That Do Not Meet Customer Needs” High ESI Materials Management System has technical problems, is being sunset or is on old architectures. Onestaff Scheduling Kronos Time & Attendance ANSOS Scheduling Bad News Technical Risk Siemens Invision Good News IDX Billing & AR IDX Scheduling & Registration OAS Admin System System has major deficiencies in functionalities and does not meet customer needs. Eclipsys TSIDec. Support ADP HR & Payroll Functional Risk High

27. SWOT Solution Matrix

28. The Many Faces of SWOT City of Aberdeen Local Transport Strategy Strategic Plan – East St. Louis Screen Shot of winswot(www.cymeon.com)

29. The PEST Analysis

31. Hardware TCO

32. The Total Cost of Ownership Pie Source: The Gartner Group

33. Costs - Initial Investment • Hardware (platforms, networks) • Software base price (operating systems, layered products, product license) • Licensing approach (perpetual, seat, site, concurrent use) • Vendor/consultant implementation fees • Interface fees • Education and training • Personnel and salaries • Ancillary personnel required (network, help desk, security, desktop support) • ASP, outsoursing fees • Can system be outsourced or ASP’s

34. Costs – Total Cost of Ownership • Maintenance and support fees • Support service levels (7X24, business hours) • New version upgrade costs (included in maintenance?) • Ongoing training • Ancillary personnel (e.g. network, help desk, desktop support)

35. Health System IR Vision - 2010 Active Enterprise Master Person Index Patient Access Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT Passive Enterprise Master Person Index Electronic Medical Record UTSW Faculty Professional Billing UMC Hospital Billing Documentation Orders Ancillaries PACS Specialty Systems Doc. Imaging Enterprise Clinical Data Repository OAS Finance/ General Ledger HRMS Human Resources/ Payroll ERP - Finance ERP – Human Resources/Payroll ERP – Materials Management Enterprise Business Decision Support

36. New Health System IR Vision - 2010 Active Enterprise Master Person Index (??????) Patient Access Clinic Scheduling Emergency Room Hospital Scheduling Hospital ADT Passive Enterprise Master Person Index Electronic Medical Record UTSW Faculty Professional Billing UMC Hospital Billing Documentation Orders Ancillaries PACS Specialty Systems Doc. Imaging Enterprise Clinical Data Repository ERP - Finance ERP – Human Resources/Payroll ERP – Materials Management Enterprise Business Decision Support

37. Free Consulting • Where would you focus your efforts Year 1 • What is the weakness of the IR Vision Picture • What projects would contribute to the creation of ‘Systemness’ • How could you break down the ‘Us and Them’ barriers rampant in IR personnel?

38. ‘Systemness” – Create a seamless experience for physicians and patients across our clinical delivery enterprise.” What Really Happened • The Glue (NOT the Mission/Vision Thang) • List of proposed projects, budgets and timelines supporting vision and goals of the organization. • The technology organization needed to successfully deliver these projects • Governance structure capable of implementation and enforcement

39. ‘Systemness” – Create a seamless experience for physicians, administrators, and patients across our clinical delivery enterprise.” OVERALL BUSINESS VISION To operate as one unified University Health System for our patients and faculty. CURRENT BUSINESS STRATEGY To improve patient and physician service as put forth in the Clinical Services Initiative. To achieve the financial/operational sustainability of Zale Lipshy & St. Paul University Hospitals. OVERALL INFORMATION RESOURCES VISION To provide our faculty with world-class IT to improve patient safety & clinical quality.

40. Our CEO The List

41. 8 IR Strategic Priorities For Yr 1 Hospitals: Optimize Revenue Cycle & Implement Hospital Scheduling ($6.15M) Hospitals: Create Clean Hospital Reporting Through TSI Optimization & Standardization ($0.6M) Ambulatory: Create Improved P & Ls ($100K) Health System: Develop Comprehensive ERP (Finance, HR, Payroll, Supply Chain) Bid – ($350K) Health System: Upgrade Infrastructure For Phones, Cabling, & Networking ($4.93M) Ambulatory: UT Smart Medical Record, Registration & Scheduling Rollout ($20M – Already Funded) Hospitals: Continue Expansion of Clinical Data Repository to Include Reporting From SPUH ($50K – Already Funded) Health System: Implementing Campus-Wide Cancer Registry ($1.3M)

42. Health System Infrastructure Plan PROJECT #1: Phones • New Phone PBX System For University, SPUH & ZLUH • Current equipment is at end of lifecycle and becoming unreliable for service needs and anticipated growth. • ZLUH is a node off of Parkland system that Perot will charge us for PROJECT #2: Cabling • Upgraded Cabling In Every Building To Support High Speed Connection • Current building network cabling and network closets are inadequate to support industry standard high-speed network connection and to meet demands of Internet2, PACS, and other bandwidth intensive applications. PROJECT #3: Secure, Redundant Campus Network • Redundant, Tiered Network To Safeguard University Resources • Current network does not provide adequate security/redundancy to protect network resources into future. PROJECT #4: Consolidate & Upgrade Data Centers For Health System • Upgrade data center for Health System with 24X7 operations model • Consolidate UMC data centers into UTSW data center, and upgrade technology to allow 24X7 network operations model necessary for ERP & clinical systems.

43. Revenue Cycle/ Patient Access Optimization PROJECT DESCRIPTION PROJECT OWNER $6.15M Redesign our front-end and back end business processes with associated configuration of existing information systems and implementation of new scheduling system to promote more accurate registration, increased charge capture, improved cash collections, and timely billing and reimbursement. CFO, Health System INTERNAL IR RESOURCES Siemens Resources (3) Softmed Resources (2) Interface Resource (1) Technical Resource (1) ADDITIONAL RESOURCES TARGETED INFORMATION SYSTEMS Project Manager (1) Front-End Process Expert (1) Scheduling Specialist (1) HIM Re-Design Expert (1) Document Imaging Expert (1) Siemens Resource (1) Siemens Invision Softmed HIM Suite New Scheduling System New Document Imaging For Hospitals BUSINESS UNITS INVOLVED TECHNOLOGY COSTS Admitting, Medical Records, Business Office, Pre-Registration, All Hospital Departments Performing Scheduling Siemens ZLUH Upgrade/Conversion New Document Imaging System

44. Develop Health System ERP Strategy PROJECT OWNER PROJECT DESCRIPTION $300K Work with University administrative departments and Health System leadership to determine appropriate information system solution(s) to meet both administrative needs of University and management needs of clinical practice. System functional requirements will be determined, vendors evaluated, and system recommendation will be made with ROI justification. CFO, University CFO, Health System INTERNAL IR RESOURCES OAS/HRMS Director (1) Hospital Apps. Director (2) INTERNAL UTSW RESOURCES Finance Analyst (1) Human Resources Analyst (1) Materials Management Analyst (1) TARGETED INFORMATION SYSTEMS OAS Administrative System Siemens GL/AP ESI Materials Management ADP Human Resources New ERP System ADDITIONAL RESOURCES Project Manager (1) Finance Expert (0.25 FTE) Human Resources (0.25 FTE) Materials Management (0.25 FTE) BUSINESS UNITS INVOLVED University Finance, Human Resources, Materials Management, Hospital Finance, HR, & Materials Management TECHNOLOGY COSTS None

45. Medical TV Telecommunications Ambulatory IT Hospital IT Client Services Network Services AdministrativeComputing The Information Resources Organization CIOVP For Information Resources 330Employees$55M Operating Budget4% of Institution Operating Budget (1.2b)

46. Restructured IT Department

47. Governance German MachineGun Crew French Infantryman (Pantalon Rouge)

48. The IT Governance Landscape Defined governance Scope (what is being governed. What is not being governed) Who makes the decision Who has input Who enforces the decision Governance mechanisms Governance style Consolidation of redundant governance structures to match ‘systemness’ theme Introduction of the Project Management Office with standard IT project reporting/time reporting framework

49. Successes • Revenue cycle reworked in re-implemented in record time. Hospitals at break-even with slight profit. Consolidated billing system increased professional fee revenues • De-install unsafe electronic medical record • VoIP with wireless installed • Campus infrastructure upgraded • Cancer registry implemented (avoided de-certification) • St. Paul integrated into UT Southwestern’s patient data warehouse and master person index • Information Resources reorganized • New data center operational

50. Not So Success • ERP discovery phase doubled. Culture clash of University and Health System • Old clinical system governance still in place. Now ineffective • Allocation of costs a continual issue. Slows IT projects • Strategic Plan scope creep • Organizational capacity to change